Prognostic relevance at 5 years of the early monitoring of neoadjuvant chemotherapy using FDG PET in luminal HER2-negative breast cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 11007-11007
Author(s):  
Olivier Humbert ◽  
Alina Berriolo-Riedinger ◽  
Alexandre Cochet ◽  
Mélanie Gauthier ◽  
Celine Charon-Barra ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Fdg Pet ◽  
Metabolic Response ◽  
Early Stage ◽  
Breast Cancer Subtype ◽  
Standardized Uptake Value ◽  
Luminal Breast Cancer ◽  
Ki 67

11007 Background: To evaluate, in the luminal breast cancer subtype, the prognostic value of tumor glucose metabolism at baseline and of its changes after one cycle of neoadjuvant chemotherapy (NAC). Methods: This prospective study included 61 women with immunophenotypically defined luminal HER2-negative breast cancer treated with NAC. 18F-FDG PET was performed at baseline. Hepatic activity was used as a reference to distinguish between low-metabolic and hypermetabolic tumors. In hypermetabolic tumors, a PET exam was repeated after the first course of NAC. The relative change in the maximal Standardized Uptake Value of the tumor (ΔSUV), corresponding to the metabolic response, was calculated. Results: Forty-two women had hypermetabolic tumors at baseline, corresponding to more proliferative breast cancers with higher Ki-67 expression (p=0.017) and higher grade (p=0.04). Nineteen women had low-metabolic tumors with lower proliferation indexes. Worse overall survival was associated with larger tumor size (>5cm, HR=6.52, P=0.009) and with hypermetabolic tumors achieving a low metabolic response after one cycle of NAC (ΔSUV<16%, HR=10.63, P=0.004). Five-year overall survival in these poor-response patients was 49.22% (95% CI=[14.76%-76.90%]). In contrast, overall survival in women with low-metabolic tumors or hypermetabolic/good-response tumors (ΔSUV≥16%) was good, 100% and 96.15%, respectively (95% CI=[75.69%-99.45%]). Conclusions: In luminal HER2-negative breast tumors, tumor metabolism at baseline and changes after the first course of NAC are surrogate markers of patients’ survival. A subgroup of women with hypermetabolic/bad-responding tumors correlated with poor prognosis can be identified. These results may create the ability to tailor the NAC regimen to the metabolic response at an early stage.

Positron emission tomography/computed tomography (PET/CT) as a biomarker of pathologic response to neoadjuvant chemotherapy in breast carcinoma.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e21147-e21147
Author(s):  
Catherine M. Kelly ◽  
Clare Smith ◽  
Susan Conlon ◽  
Reem Salman ◽  
John McCaffrey ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Carcinoma ◽  
Neoadjuvant Chemotherapy ◽  
Lymph Nodes ◽  
Breast Cancer Subtype ◽  
Standardized Uptake Value ◽  
Predictive Biomarkers ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Pet Ct

e21147 Background: Pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) in breast carcinoma is prognostic. Predictive biomarkers for pCR include early response to NAC, estrogen receptor (ER) negativity, HER2 positivity, and high Ki67. We assessed whether absence of fluoro-deoxy glucose (FDG) uptake measured by standardized uptake value (SUV) after NAC would predict pCR. Methods: We identified 23 patients (pts) who had PET/CT scanning pre and post NAC. We examined breast cancer subtype, chemotherapy (CT) regimen, number of cycles of CT given, clinical and pathological staging data and changes in SUV in the breasts and lymph nodes pre and post NAC. pCR was defined as no residual cancer in the breast or axillary lymph nodes. Results: Median age at diagnosis was 46 years (IQR; 37 to 56). Median tumor size at diagnosis was 30mm (IQR; 25 to 43) and 19 pts (83%) had node positive breast cancer. Most tumors were ductal (n=22) with 1 lobular cancer. Preoperatively 95% received all CT. All HER2+ pts received Trastuzumab. Anthracycline/taxane based regimens were most frequently given in 22 cases, 1 received lapatinib/trastuzumab. Five tumors (21.7%) were ER+/HER2+; 14 (60.9%) ER+/HER2-; 2 (8.7%) ER-/HER2+ and 2 (8.7%) were ER-/HER2-. All tumors were high (n=9, 39.1%) or intermediate grade (n=14, 61%). SUV was significantly lower post NAC (p=0.035). We observed no SUV uptake in breast or lymph nodes in 15 cases (65.2%) post NAC, these corresponded to; ER+HER2+ 4/5 (80%); ER+HER2- 7/15 (46.7%); ER-HER2- 2/2(100%), ER-HER2+ 2/2(100%). Absent SUV uptake post NAC was associated with a pCR (breast and lymph nodes) in 5/15 (33%) of pts (ER+HER2+ n=1, ER+HER2- n=1, ER-HER2- n=2, ER-HER2+ n=1). Ten of 15 tumors (67%) had no SUV uptake in the breast post NAC and 7 (47%) were associated with a pCR. There was a trend toward increased odds of pCR with no SUV uptake post NAC (OR 2.76; 95% CI 0.85 to 8.94: P= 0.09). Overall rate of pCR was 21.7% (n=5). Conclusions: A non-statistically significant trend toward increased odds of pCR with no SUV uptake post NAC was observed. Larger subtype-specific breast cancer cohorts will be required to determine the value of PET/CT as a predictive biomarker for pCR.

scholarly journals 18F-fluorodeoxyglucose (FDG) PET or 18F-fluorothymidine (FLT) PET to assess early response to aromatase inhibitors (AI) in women with ER+ operable breast cancer in a window-of-opportunity study

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Perrin E. Romine ◽  
Lanell M. Peterson ◽  
Brenda F. Kurland ◽  
Darrin W. Byrd ◽  
Alena Novakova-Jiresova ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Pet Imaging ◽  
Fdg Pet ◽  
Early Stage ◽  
Early Response ◽  
Window Of Opportunity ◽  
Ki 67 ◽  
Flt Pet ◽  
Post Therapy

Abstract Purpose This study evaluated the ability of 18F-Fluorodeoxyglucose (FDG) and 18F-Fluorothymidine (FLT) imaging with positron emission tomography (PET) to measure early response to endocrine therapy from baseline to just prior to surgical resection in estrogen receptor positive (ER+) breast tumors. Methods In two separate studies, women with early stage ER+ breast cancer underwent either paired FDG-PET (n = 22) or FLT-PET (n = 27) scans prior to endocrine therapy and again in the pre-operative setting. Tissue samples for Ki-67 were taken for all patients both prior to treatment and at the time of surgery. Results FDG maximum standardized uptake value (SUVmax) declined in 19 of 22 lesions (mean 17% (range −45 to 28%)). FLT SUVmax declined in 24 of 27 lesions (mean 26% (range −77 to 7%)). The Ki-67 index declined in both studies, from pre-therapy (mean 23% (range 1 to 73%)) to surgery [mean 8% (range < 1 to 41%)]. Pre- and post-therapy PET measures showed strong rank-order agreement with Ki-67 percentages for both tracers; however, the percent change in FDG or FLT SUVmax did not demonstrate a strong correlation with Ki-67 index change or Ki-67 at time of surgery. Conclusions A window-of-opportunity approach using PET imaging to assess early response of breast cancer therapy is feasible. FDG and FLT-PET imaging following a short course of neoadjuvant endocrine therapy demonstrated measurable changes in SUVmax in early stage ER+ positive breast cancers. The percentage change in FDG and FLT-PET uptake did not correlate with changes in Ki-67; post-therapy SUVmax for both tracers was significantly associated with post-therapy Ki-67, an established predictor of endocrine therapy response.

Improving the effectiveness of neoadjuvant chemotherapy in patients with breast cancer with positive estrogen receptor (HR) and HER2 negative.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e12120-e12120
Author(s):  
Serafin Morales ◽  
Ariadna Gasol Cudós ◽  
Juan Felipe Cordoba Ortega ◽  
Maria Jose Panades Siurana ◽  
Felip Vilardell ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Progesterone Receptor ◽  
Tumor Size ◽  
Breast Cancer Subtype ◽  
Pathologic Complete Response ◽  
High Rate ◽  
Luminal Breast Cancer ◽  
Ki67 Index ◽  
Rate Of Response

e12120 Background: The effect of pathologic complete response (pCR) after neoadjuvant chemotherapy is considered independent of the breast cancer subtype, but the pCR rate in HR positive/HER2 negative patients is smaller than other subtype so it is interpreted as pCR is not being prognostic in luminal breast cancer. In large series residual cancer burden (RCB) assessed by Symmans methods is prognostic in luminal patients if RCB-0 and RCB-I are combined. Methods: 166 patients (March 2000-august 2016) with neoadjuvant chemotherapy based treatment were retrospectively analysed in order to find if common clinicopathological factors could select patients with significative better response considered as pCR or RCB type 0 and I. Results: Median age was 53 years (29-82), median tumor size of 41 mm and 54% of tumors had initial nodal involvement. All patients were estrogen positive and 45% progesterone receptor negative with a median of ki67 expression of 32%. A total of 10% pCR rate was found and the response type RCB 0 and 1 according to Symmans method was 22%. In the univariate model we found and association with pCR and: progesterone receptor negative (p=0.017; OR 4,3), initial tumor size (p=0.026; OR 0,95) and Ki67 index > 30% (p=0.009; OR 5.3). An association with progesterona receptor negative (p=0.008; OR 3,1) was found with the the RCB type 0 and I response. Conclusions: Factors related to better response to neaodjuvant chemotherapy are progesterone receptor negative and level of Ki67 index. Considering this parameters we could found a high rate of response with 24% of pCR and 35% of RGB type 0 and I being the best rate of response in luminal patients.

scholarly journals Utility of FDG-PET/CT in the Evaluation of the Response of Locally Advanced Breast Cancer to Neoadjuvant Chemotherapy

2014 ◽  
Vol 99 (4) ◽  
pp. 309-318 ◽  
Author(s):  
Kei Ogino ◽  
Masanobu Nakajima ◽  
Miyako Kakuta ◽  
Mitsuhiro Hayashi ◽  
Satoru Yamaguchi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Fdg Pet ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Reduction Rate ◽  
Standardized Uptake Value ◽  
Pet Ct ◽  
Significant Difference ◽  
Fdg Pet Ct

Abstract Neoadjuvant chemotherapy (NAC) is effective in down-staging a primary tumor before surgery, and quick differentiation between responders to NAC and nonresponders is needed. We investigated the utility of [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) and computed tomography (CT) in evaluating the therapeutic effectiveness of NAC. We investigated 25 patients who underwent NAC for stage II and III noninflammatory breast cancer. FDG-PET/CT was undertaken before and after NAC to determine the maximum standardized uptake value (SUVmax) reduction rate. Findings were compared with postoperative histopathologic evaluation of therapeutic response. It was not possible to accurately assess tumor response to NAC using CT. However, using the SUVmax reduction rate, we noted a significant difference (P = 0.0420) between patients who were responsive and nonresponsive to NAC. The sensitivity and specificity were as high as 83.3% and 78.9%, respectively. This study demonstrated that FDG-PET/CT can differentiate responders from nonresponders. This improves patient management by avoiding unnecessary chemotherapy.

scholarly journals Early Metabolic Response to Neoadjuvant Treatment: FDG PET/CT Criteria according to Breast Cancer Subtype

Radiology ◽  
2015 ◽  
Vol 277 (2) ◽  
pp. 358-371 ◽  
Author(s):  
David Groheux ◽  
Mohamed Majdoub ◽  
Alice Sanna ◽  
Patricia de Cremoux ◽  
Elif Hindié ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Fdg Pet ◽  
Metabolic Response ◽  
Breast Cancer Subtype ◽  
Neoadjuvant Treatment ◽  
Pet Ct ◽  
Cancer Subtype ◽  
Fdg Pet Ct ◽  
Early Metabolic Response

scholarly journals Meta-analysis of nanoparticle albumin-bound paclitaxel used as neoadjuvant chemotherapy for operable breast cancer based on individual patient data (JBCRG-S01 study)

Breast Cancer ◽  
2021 ◽  
Author(s):  
Manabu Futamura ◽  
Mari Oba ◽  
Norikazu Masuda ◽  
Hiroko Bando ◽  
Morihito Okada ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Breast Cancer Subtype ◽  
Patient Data ◽  
Operable Breast Cancer ◽  
Breast Cancers ◽  
Ki 67 ◽  
Phase Ii Studies

Abstract Background Nanoparticle albumin-bound paclitaxel (nab-PTX), a novel taxane formulation, was developed to avoid cremophor/ethanol-associated toxicities including peripheral neuropathy and hypersensitivity. At least 35 phase II studies using combined nab-PTX and anthracycline in neoadjuvant settings are registered in Japan. We analyzed the efficacy and safety of nab-PTX based on patient characteristics in these studies. Methods We conducted a meta-analysis using individual patient data (IPD) to investigate the average efficacy of nab-PTX-containing regimens as neoadjuvant chemotherapy for operable breast cancer. IPD were provided by principal investigators who agreed to participate. The primary endpoint was pathological complete response (pCR) rate of each breast cancer subtype. Results We analyzed the data of 16 studies involving 753 patients. The overall crude frequencies of pCR (ypT0 ypN0, ypT0/is ypN0, and ypT0/is ypNX) were 18.1, 26.0, and 28.6%, respectively. Specifically, the frequencies were 6.7, 10.2, and 13.4% for luminal (n = 343); 40.5, 63.5, and 68.9% for human epidermal growth factor receptor 2 (HER2)-rich, (n = 74); 21.9, 40.6, and 42.7% for luminal/HER2 (n = 96); and 26.3, 31.5, and 32.3% for triple-negative breast cancers (TNBC) (n = 232). The multivariate analyses indicated that HER2 positivity, TNBC, high Ki-67, high nuclear grade, and weekly nab-PTX administration were significantly associated with the pCR. The proportion of hematological toxicities (neutropenia (39.7%) and leukopenia (22.5%)), peripheral sensory neuropathy (9.7%), myalgia (5.7%), and arthralgia (4.7%) was higher than grade 3 adverse events, but most patients recovered. Conclusions Nab-PTX is a safe and acceptable chemotherapeutic agent in neoadjuvant settings, particularly for aggressive cancers. UMIN-CTR#: UMIN000028774

Subpopulation composition of tumor-infiltrating lymphocytes in luminal breast cancer and its effect on effectiveness of neoadjuvant chemotherapy

2020 ◽  
pp. 32-37
Author(s):  
E. I. Kovalenko ◽  
E. V. Artamonova ◽  
T. N. Zabotina ◽  
Z. G. Kadagidze ◽  
S. G. Bagrova ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Initial Level ◽  
Tumor Infiltrating Lymphocytes ◽  
Cancer Prognosis ◽  
Luminal Breast Cancer ◽  
Tumor Subtype ◽  
Luminal A ◽  
Ki 67 ◽  
Infiltrating Lymphocytes

Tumor-infiltrating lymphocytes (TILs) play a key role in the formation of anti-tumor immunity and, as studies have shown, can be one of the markers of treatment effectiveness and cancer prognosis. The aim was to study the subpopulation composition of the lymphoid infiltrate in early luminal breast cancer in patients receiving neoadjuvant chemotherapy (NACT) and its effect on achieving a pathological complete response (pCR). Materials and methods. We included 24 patients who received anthracycline-taxane-contain-ing preoperative chemotherapy. The subpopulation composition of TIL was assessed in core-biopsy samples before starting NACT in all patients; after treatment, the assessment was made on postoperative material. The analysis was carried out by flow cytometry. Clinical and immunological assessment was carried out for the following seven subpopulations of lymphocytes: CD3+, CD3+CD4+, CD3+CD8+, CD4+CD127+CD25+, CD3 CD19+ CD3CD16+CD56+, CD3+CD16+CD56+. Results. The incidence pCR was 16.7 %. It was revealed that the initial level before treatment of CD3+, CD3+CD4+, CD3+CD8+, CD4+C-D127+CD25+, CD3-CD19+, CD3 CD16+CD56+, CD3+CD16+CD56+ lymphocytes did not differ depending on the stage of the disease (II or III), tumor subtype (luminal A/B) and Ki-67 level (up to 20, 20-39, 40 and more). No correlations were found between Ki-67 and TIL content. When conducting regression analysis, it was revealed that only the level of CD3+, CD3+CD8+ and CD19+ was a significant factor in achieving a pCR (p = 0.005). When an empirical subgroup was identified, which was characterized by a high content (above or equal to the median) of CD3+, CD3+CD8+ and low (below the median) CD19+ (four observations), the frequency of pCR reached 75 %. Conclusion. Thus, the initial level of T-lymphocytes (CD3+, CD3+CD8+) and B-lymphocytes (CD19+) in the tumor, regardless of the stage of the disease, tumor subtype, ki-67 index, was a predictor of high sensitivity to neoadjuvant chemotherapy of luminal breast cancer and was associated with higher frequency of pCR.

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